A Primer on
Medical Student Well-Being
American Medical Student Association
1902 Association Drive
Reston, VA 20191
This and other publications are available through the
American Medical Student Association
1902 Association Drive
Reston, VA 20191
(703) 620-6600
Web site: www.amsa.org
This resource was researched, prepared and written by
Eunice Marie Santiago
AMSA Well-Being Intern
esantiago@medmail.com
and Eric Hodgson
AMSA Director of Student Programming 2000-2001
ejmdreston@aol.com
Do you have any comments, questions, or concerns?
Please contact the Director of Student Programming
At (703) 620-6600 ext. 270
dsp@www.amsa.org
TABLE OF CONTENTS
INTRODUCTION
5
AMSA’s MISSION
5
STRESSING OUT
LOSING CONTROL (Suicide)
CHECKS AND BALANCES
COPING STRATEGIES/LEARN TO RELAX
6
6
7
7
DAZED AND CONFUSED (Sleep Deprivation)
THE OPPOSITION
YOU ARE NOT ALONE
SO…SLEEP ON IT
8
8
8
9
ON SUBSTANCE ABUSE
DRINK LIFE TO THE LEES
QUICK FACTS
10
10
10
ON A CULTURE OF ABUSE
PUTTING WORDS INTO ACTIONS
11
11
FREQUENTLY ASKED QUESTIONS
12
ONLINE RESOURCES
13
NOTES FOR CONCERNED MEDICAL STUDENTS
BY PATCH ADAMS
14
CITATIONS
15
GOOD “WELL” HUNTING
The Wellness Balance Model
Physical
Physical fitness/Ability/Active living
Body Awareness/Positive body
image acceptance
Nutrition/Eating behaviors
Safety/Injury prevention
Substance Use:
alcohol and other drugs (prescription,
non-prescription, tobacco)
Sexual health/STIs/Pregnancy
Medical history/Self-care
Intellectual
Critical thinking/Problem-solving
Mental status/Abilities/Challenges
Stimulation/Creativity
Education/Learning history
Adaptation to change
Accessing resources
Occupational
Career planning/Academic program
Occupational interests/Influence of
others
Work history/Skills
Economic outlook
Vocation/Avocation/Leisure balance
Child-rearing/Homemaking
Volunteerism
Spiritual
Sense of belonging/Bonding
Religious/Spiritual history/Belief
system
Sense of purpose/Direction/Meaning
Beliefs about death/suffering
Willingness to seek guidance
Life satisfaction/Positive acceptance
of life
Social
Interdependence/Willingness to seek
help from and give help to others
Finances/Housing
Interaction of self with community
and environment
Psychosocial history/Social network
Relationship style/Significant
relationships
Acceptance of others regardless of
race, ethnicity, religion, gender,
ability or sexual orientation
Emotional
Self-awareness/Self-esteem/
Self-efficacy
Positive attitudes/Values/Beliefs
Communication skills
Coping skills/Assertiveness
Decision-making skills
Caring/Healthy relationships
Mental health/Psychiatric history
NOTE: The wellness balance model and the dimensions of wellness information given
above are taken from Student Health Service (1999). Wellness Planning Guide. The University of B. C.
©American Medical Student Association/Foundation, 2001
INTRODUCTION
and suicide. These statistics are extremely
For centuries, medicine has been regarded as
alarming because they represent those
a gratifying and honorable career. Medical
students start their education with a sense of
individuals entrusted with the health care of
our nation.
commitment,
enthusiasm,
optimism,
altruism, and idealism, while graduate
Altogether, if a future physician’s potential
doctors are expected to be caring,
is reduced or destroyed by any of these
humanistic, compassionate, and dedicated to
1
factors, the result will inevitably be poor
their patients.
healthcare delivery. Thus, it is imperative to
encourage medical schools as well as
However, the pursuit of a medical career
students to assume responsibility for their
exacts a heavy toll on the student’s health
own physical, mental, and spiritual welland well-being, since there is a heavy
being.
emphasis on technical excellence and
amassing of information with little regard of
Considering that the philosophy that
students’ social and emotional development.
underlies the promotion of health and wellThere is generally a shift to a more cynical
being is based in primary prevention, this
and hedonistic orientation during medical
primer aims to 1) provide an overview of
school as well as significant elevations and
2
various well-being issues pertaining medical
increases in depression and anxiety.
education; 2) illustrate how a lack of
Increasing attention has been paid to the
physical and emotional wellness proves to
problems affecting the medical population
be detrimental to medical students; and 3)
with rather startling statistics that describe
provide students with a list of available
significant amounts of drug and alcohol
resources to better understand and cope with
abuse, severe depression, deleterious effects
the multiple stresses inherent in medical
of sleep deprivation, medical student abuse,
education.
AMSA’s MISSION
AMSA is committed to improving health
profession of medicine; to contributing to
care and health care delivery to all people; to
the welfare of medical students, interns,
promoting active improvement in medical
residents, and post-MD/DO trainees; and to
education; to involving its members in the
advancing the profession of medicine.
social, moral and ethical obligations of the
“The purpose of AMSA is to promote improvements in health sciences education so that the
educational environment fosters growth of the student as an integrated mental, physical, and
spiritual being. AMSA defines health as a positive, dynamic state of physical, mental, and
environmental well-being, and therefore, believe that health care should be oriented toward
the achievement of health and not solely a treatment of disease.” (AMSA-1977)3
“Enthusiasm is contagious. Be a carrier” –Susan Rabin
5
©American Medical Student Association/Foundation, 2001
STRESSING OUT
! Anger/Irritability
Stress is a normal part of everyone’s life. A
! Weight Gain/Loss
certain amount of stress clearly enhances
! Ulcers
performance and productivity. When
properly handled, stress can make your life
more interesting and exciting.
According to recent studies, the rise in
depression scores and their persistence over
A recent study4 found that those medical
time suggests that emotional distress during
students participating in stress-management
medical school is chronic and persistent
programs demonstrated:
rather than episodic.5 At one medical school,
12% of the students became clinically
• Improved immunologic functioning
depressed during their first year6, and 30%
• Decreases in depression and anxiety
of residents during their intern year.7
• Increased spirituality and empathy
A number of studies have beem conducted
on the perceived stressors, problems, and
concerns of medical students such as:
• Academic demands
• Financial responsibilities
• Sleep deprivation.
However, stress can become oppresive when
it is not managed properly giving rise to a
series of physical, mental, and spiritual
difficulties.
Among the most common
effects caused by stress are:
! Depression
! Headaches
! Hypertension
“Physicians should strive to manage professional and personal stress to maintain their own health and wellbeing and to maximize their ability to provide quality health care to their patients.” (CMA Policy, 1998)8
LOSING CONTROL
( Suicide)
Suicide is a critical issue among the medical
population. Each year, physician suicide
removes from the U.S. a number of
physicians equal to the size of a medical
school graduating class.9
At present, researchers have been unable to
establish absolute causes for suicide among
this population. However, there are a series
of factors that have been identified as
precursors to suicide such as:
♦ Alcohol/substance abuse
♦ Previous psychiatric history
♦ Violent/aggressive behavior
According to a study performed in 199610,
suicide ranks second among the leading
causes of death among medical students;
40% of these occurred in the junior year. As
for physicians, the estimated suicide rate is
twice that of the general population-- selfpoisoning with prescribed drugs the
predominant method.11
Other potential risk factors inherent in
medical education such as work stress and
sleep deprivation may contribute to the
suicide rates. For this reason, students and
physicians must cooperate and seek help
before it’s too late.
“The moment man begins to question the meaning and value of life he is sick” –Sigmund Freud
6
©American Medical Student Association/Foundation, 2001
CHECKS AND BALANCES
The health benefits of emotional ventilation
functioning relationship, be it with a patient,
and support have been proclaimed for
a friend, a professor, or a significant other,
centuries. Physicians who balance work,
requires a sense of working harmoniously
family, physical, emotional, and spiritual
together12--it can brighten your day.
Likewise, a healthy intimate relationship is
needs are happier, healthier, clearer in
vital to most people, including physicians.
thought, more energetic, and more
The medical profession needs a cultural shift
accepting. While this may seem like the
physicians’ Utopia, it is definitely attainable.
from the belief that a physician’s calling
transcends family life.
Healthy relationships are a key component
of achieving balance. A healthy and
“We cannot direct the wind but we can adjust the sails” –Anonymous
COPING STRATEGIES☯LEARN TO RELAX
Create a relaxing scene, for a moment,
It is very important for medical students to
acknowledge that some stress factors are
daydream your cares away.
controllable and others are not. We may not
Cultivate humor. Sometimes laughter is the
be able to get rid of stressful events, but we
best medicine. Laughter has been shown to
release hormones into the brain that make
can certainly control the way in which we
deal with them.
you feel good. ☺
Avoid self-medication. Always consult
Know your limits. It's okay to say "no" to
your physician if you feel sick or depressed.
extra commitments and projects.
Assess your stress. Make an effort to
Self-medication may be habit-forming,
reduce your efficiency, and create even
master, overcome, or counteract your
stressors instead of trying to live with or
more stress.
escape them.
Change the scenery. Go for a brisk walk.
Light exercise can be refreshing.
Be good to yourself. Eat a well-balanced
diet; avoid caffeine and fatty foods. Take a
There may be times when you feel your
stress and its effects become too great for
break from your daily routine to just relax.
Share your stress. Talk to someone you
you to handle alone. Before stress gets out
trust about your concerns and worries.
of hand, seek professional help to prevent a
Imagery. Translate your feelings into ideas.
more serious situation later on.13
“AMSA supports the development of high quality, confidential counseling services for
students desiring such services and encourages efforts to educate both students and faculty
as to the benefits of such counseling so as to dispel the myth that recourse to counseling is
an indication of weakness in the student; we also support the confidentiality of medical
student health and counseling records and affirm that the student, as patient, deserves, as
does anyone, the privilege of confidentiality between doctor and patient.” (AMSA-1977)
“The trouble with life in the fast lane is that you get to the other end in an awful hurry” -J.J.
7
©American Medical Student Association/Foundation, 2001
DAZED AND CONFUSED
( Sleep Depriv a t io n)
•
Most adults need around eight hours of sleep
for peak alertness and energy. Due to a
myriad of reasons ranging from insomnia to
work schedules and even having a baby, this
has become the exception, not the rule.
•
•
•
•
•
Sleep deprivation is one of the main causes
of
physician-in-training
impairment.
Researchers have found that prolonged
periods of duty without sleep adversely
affect practitioners, both in their well-being
and in their ability to carry out simple
tasks.14 Sleep deprivation can produce
severe psychological symptoms such as
perceptual and mood changes, psychosis,
irritability, decreased ability to concentrate,
and anxiety.15
Increased fatigue, depression, and
hostility16
Poor psychomotor performance
Deterioration
of
doctor-patient
relationships
Recent memory loss
Extreme sensitivity to criticism17
Car accidents-death18
In 1984, Libby Zion, an 18 year old girl,
died because of an adverse reaction to two
medications. After the investigation, the
grand jury concluded that the long working
hours of residents had contributed to her
death, and the doctors were required to pay
$375,000 to the Zion family for pain and
suffering.19 On account of this, in 1989
New York became the only state in the U.S.
to regulate resident hours, as established by
the Public Health Law Code 405, known as
the Bell Regulations.20
Among the prevailing effects caused by
sleep deprivation are:
THE OPPOSITION
To add insult to injury, Dr. Ward Griffen,
You may think the Bell Regulations solved
the problem. However, the situation is less
head of the American Board of Surgery,
than ideal. Although the regulations are in
emphatically stated that he thinks, “it’s the
place in NY, they are not always enforced.
biggest bunch of hogwash there is. All this
According to an investigation performed in
jazz about sleep deprivation is way
overplayed…I think the people who are
199821, nearly all the residents at the seven
hospitals investigated in NYC worked
pushing this are the ones who can’t get by
longer hours than the laws allow (surgery
on a little sleep.”22
programs being the worst offenders.)
YOU ARE NOT ALONE
“AMSA recognizes that patient care and medical education suffer when students and
housestaff lack proper rest; believes that students should be allowed to negotiate working
hours and conditions with their respective medical institutions; and therefore supports and
will work toward the implementation of regulations, including those at the federal level, which
will regulate resident work hours with the intent of providing a better standard of care for all
patients and more humane working conditions for residents.” (AMSA-1977)
“Health care students can be taught from the beginning of their careers that they have as much responsibility for
their own sanity and physical well-being as they do for those qualities in the lives of their patients.”
–Donald A. Block, M.D
8
©American Medical Student Association/Foundation, 2001
SO…SLEEP ON IT!
There is still much to be done regarding
things students can do to improve their
residents’ working hours and it will take
health, thus, ensuring a successful career as
some time. Nevertheless, there are many
physicians and a better healthcare delivery.
“Let us emancipate the student, and give him time and opportunity for the cultivation of his mind, so that in his
pupilage he shall not be a puppet in the hands of others, but rather a self-relying and reflecting being.”
–Sir William Osler
Second: Beat Insomnia
1) Maximize your comfort. A firm mattress
and pillow work best. Make your room
quiet, dark and cool with good air
circulation. To block out traffic or other
noise, try ear plugs or soothing nature tapes.
2) Take a warm bath. Baths help lower your
body’s temperature which makes you feel
sleepier.
3) Drink warm milk or herb tea. Milk and
bananas contain L-Tryptophan, which is
thought to induce sleepiness. Herb tea is a
good substitute for those who are avoiding
dairy products. The ritual of drinking
something warm can relax you.
4) Do some light reading. Choose a book
that you can put down easily—a humorous
work, a short story, a favorite childhood tale.
5) Savor your last hour before bed. Save
intense conversation for another time. Avoid
TV altogether—the flickering lights
stimulate your nervous system.
Did you know?
First: Why Can’t You Sleep?
According to the National Commission on
Sleep Disorders of Research, insomnia
afflicts about 40% of women and 30% of
men. The following are the top five factors:
• Stress—Stress increases heart rate and
blood pressure, raising arousal level.
• Depression—Depressed people often wake
up early and have trouble falling asleep
again,
a
condition
called
“sleep
maintenance” insomnia.
• Alcohol—Alcohol may help you fall
asleep, but it results in light, fragmented
sleep. After the sedative effect wears off,
usually in four hours, there is a rebound
effect that can leave you wide awake in the
middle of the night. One drink or glass of
wine is okay with dinner, but no alcohol
within two hours of bedtime.
• Caffeine—Coffee, cola and other
caffeinated substances produce a buzz, not
by jazzing us up, but by preventing us from
slowing down. Caffeine buzz lasts 6-8
hours, so if you can’t sleep, limit caffeine to
early in the day or avoid it altogether.
• Food or exercise too close to bedtime—
Both vigorous exercise and eating a meal
temporarily boost the body’s metabolism,
which can chase away sleep. Schedule a
strenuous workout or a big meal no less than
three hours before bedtime. This gives the
heart rate and metabolism time to slow
down enough for sleep.
Peak hours for…
Creativity
9–11 am
(good time to do most of your important
work)
Day Dreaming
2 pm
(good time for artists and writers)
Coordination and reflexes 5 pm
(great time to exercise)
“Healthy medical students are likely to become healthy doctors who can then
model and promote healthy lifestyles with their patients.” –Dr. Thomas M. Wolf
9
©American Medical Student Association/Foundation, 2001
ON SUBSTANCE ABUSE
For instance, a Surgeon General’s report on
Research studies have shown that the
prevalence of alcohol and illicit drug abuse
smoking and health concluded that between
among physicians is similar to that of the
10% and 25% of smokers who are advised
to quit by their physician quit smoking or
general population, while abuse of
prescription drugs may be more prevalent.23
reduce the amount they smoke. 25
Substance abuse gives cause for concern not
only because medical students themselves
may suffer as a result, but also because of
the potential impact on their effectiveness as
tomorrow’s doctors.24 The preventive care
beliefs and practices of health professionals
are noted by the general public and
influences patient behavior, since physicians
are almost unquestioned in their judgements.
On the other hand, studies have repeatedly
shown that the medical profession as a
whole tends to have negative attitudes
towards the management of patients with
substance abuse problems.26 In which case,
it is fair enough to think that they will be
less likely to acknowledge the problem in
themselves.
“AMSA aims to promote improvements in health sciences education so that it fosters a compassionate
understanding of substance abuse problems and mental illness, with a goal toward reducing their stigma in the
profession and for the public at large.” (AMSA-1977)
DRINK LIFE TO THE LEES
Inclusion of substance abuse programs in
medical institutions should concentrate their
medical schools’ curricula has proven to be
efforts on the implementation of programs
very successful. Students learn about the
directed toward prevention, treatment, and
nature of chemical dependency and its
rehabilitation. Currently, there are no
treatment, thereby, gaining critically
absolute ways to prevent substance abuse.
important skills in caring for themselves and
However, what can be done is to create
their patients, as well as monitoring the
awareness among your peers about the
activities of their peers.27 Accordingly, if the
devastating physical and emotional effects
problem of substance abuse among medical
substances such as tobacco, alcohol, and
students is to be adequately addressed,
other
drugs
can
cause.
QUICK FACTS
If you keep doing it…
Your kids are more likely to pick up your bad habits
You can have more trouble getting pregnant
Your child has double the risk of ADD
You may become impotent
You can develop cancer
If you quit…
Your blood pressure normalizes
Your chance of heart attack decreases
Your sense of smell and taste improves
You circulation and breathing improve
You will eliminate that stress
“In a word, I was too cowardly to do what I knew to
be right, as I had been too cowardly to avoid doing
what I knew to be wrong.” -Charles Dickens
“You cannot run away from weakness; you must
some time fight it out or perish; and if that be so,
why not now, and where you stand?”
-Robert Louis Stevenson
10
©American Medical Student Association/Foundation, 2001
ON A CULTURE OF ABUSE
This culture of abuse conflicts with the
Since the 1960’s medical student abuse,
renewed commitments of medical
in the form of hostility and harassment,
educators and practice professionals to
has been recognized as a problem in
instill in students a higher degree of
American medical schools.28 This
controversial issue has been repeatedly
professionalism
and
cultural
30
sensitivity.
neglected by many, regardless of the
substantial evidence in literature
documenting the prevalence and
Silver and Glicken defined abuse as: “to
deleterious effects of these practices.
treat in a harmful, injurious, or offensive
way; to attack in words; to speak
Surprisingly enough, it wasn’t until the
insultingly, harshly, and unjustly to or
1980’s that medical student abuse was
about a person.”31 These avoidable,
unnecessary, and harmful abuses have a
properly addressed through academic
research and preventive practices.
long-term negative effect on students,
resulting in inferior learning, lowered
Despite these facts, medical schools’
self-esteem, depression, and lessassociate and assistant deans consistently
effective patient care. Moreover,
deny the existence of abuse at their
students have even considered dropping
institutions attributing negative feelings
experienced
by
students
to
a
out of school due to this continuous
“challenging clinical curriculum.”29
mistreatment.32
“AMSA believes that all medical students have the right to learn in an environment free from harassment and
discrimination based on ethnicity, sex, sexual orientation, religion, disability, or gender; thus, supports this right
with all available means, including referral to legal services.” (AMSA-1997)
PUTTING WORDS INTO ACTIONS
If real, genuine changes are to be effected,
and free from retaliation complaint-handling
medical students and faculty, as well as
procedures;
and
conduct
preventive
institutions as a whole must take assertive
educational programs.
actions on preventing student abuse. A few
Rights and Duties: Institutions must focus
procedures proposed by researchers in this
on the wide promulgation of their respective
field, and established by the LCME are as
rights and duties to students, faculty
33
follows :
members, residents, and nurses.
Accreditation standards: All faculty
Respect and Accountability: Students, as
members, including residents, must be fully
well as faculty members, must be made
informed about the educational objectives of
accountable for their actions and properly
the courses and be prepared for their roles as
evaluated for either promotion or
teachers and educators of medical students.
penalization.
Effective teaching requires knowledge of the
Drawing the line: Students and faculty must
discipline and an understanding of
come to terms with a clear definition of
pedagogy. Medical schools must define the
abuse, setting it apart from perceived
standards of conduct in the teacher-learner
mistreatments in order to foster a stimulating
relationship; develop timely, confidential,
and humanistic learning environment.
"I have sworn upon the altar of God, eternal hostility against every form of tyranny over the mind of man."
-Thomas Jefferson
11
©American Medical Student Association/Foundation, 2001
FREQUENTLY ASKED QUESTIONS
promotion programs for medical
1. What is the Medical Student Bill of
students.
Rights (MSBR)?
The MSBR was adopted by AMSA in
4. Are there any other primers on well1999 as part of its Principles regarding
being issues?
students’ rights and responsibilities. You
Certainly, at present, the following
primers are available: A Primer on
can
access
it
online
at
http://www.amsa.org/sc/msbr.html
Resident Work Hours: A Patient’s Safety
Concern, and Medical Student Activism:
2. What are the Bell Regulations?
After the death of Libby Zion in 1984,
A Primer on Domestic and International
the Ad Hoc Advisory Committee on
Tobacco Control. They are available
through the AMSA National Office, or
Emergency Services (1987), chaired by
Dr. Bertrand Bell, was formed to review
you may contact the Director of Student
Programming at 1·800·767·2266 ext.270
the grand jury’s report. The committee
or at dsp@www.amsa.org.
issued recommendations for graduate
medical education reform to the New
5. How can I get involved in wellness
York State Department of Health. In
issues?
1989 these recommendations became
There are many ways to address
part of the New York State Health Code
wellness at your medical school. On the
under Section 405, limiting residents’
AMSA Website, you can find several
working hours. They are commonly
program ideas that have been tried at
known as the Bell Regulations, after
medical school campuses across the
Bell. You can find a copy of this section
country. You can also work at the
through our Web site or at
AMSA national office in Reston, VA,
http://www.health.state.ny.us/nysdoh/phf
for a month as a Well-Being intern with
orum/nycrr10.htm (Table of Contentsthe Director of Student Programming.
Search: section 405.4/ “medical staff”).
You can always contact the DSP at
or
at
dsp@www.amsa.org
3. Where can I find research papers on
1·800·767·2266 ext. 270 to talk about
medical student well-being issues?
AMSA has compiled an extensive
ways to get involved or to discuss any
wellness issue.
bibliography on numerous research
papers, including the ones cited on this
6. What can I do if I feel that I am being
primer, which will be made available
abused or mistreated at my school?
through our Medical Student Well Being
AMSA has an advocacy Board that can
web page at www.amsa.org. The topics
help you sort out your rights as a
included
are:
stress,
depression,
student. Contact the DSP at the number
substance abuse, medical student abuse,
above for more information.
suicide, well-being programs and
committees, health policy, and health
“It is not so much that we need to be taken out of exile. It is that the exile must be taken out of us”
- The Lubavitcher Rebbe
12
©American Medical Student Association/Foundation, 2001
♦
♦
♦
♦
ONLINE RESOURCES
if trying to cut your caffeine intake, or
http://www.amsa.org/well
just want to learn more about it.
AMSA’s Medical Student Well-Being
Web Page. Contains information on
♦ http://www.cspinet.org./reports/food.htm
various well-being issues, the Medical
Here’s a list of food additives to avoid,
Student Bill of Rights, Well-Being Topic
this site tells you which ones and why.
of the Month, MSWB Programming
♦ http://www.mindtools.com/
Ideas, Internship Opportunities, Online
This site gives you some ideas on stress
Resources in PDF format, and more.
and time management. It’s also “a
resource of thinking skills, shareware
http://intelihealth.com
InteliHealth is one of the leading online
and practical psychology helping you to
health information companies in the
think your way to an excellent life!”
world. It is a subsidiary of, and funded
♦ http://primusweb.com/fitnesspartner/libr
by Aetna U.S. Healthcare. It contains
ary/weight/stresmgt.htm
reliable
information
on
health
Here you will find some very useful
promotion, well-being, stress-reduction,
stress-management techniques.
nutrition, and more.
♦ http://students.ubc.ca/health
http://www.cma.ca
This is the University of British
This is the Canadian Medical
Columbia Student Health Web site. Here
Association web page. It contains useful
you will find information on health,
information on well-being policies
illness, and wellness issues from a
adopted
in
this
country
medical perspective.
http://www.cma.ca/inside/policybase/19
♦ http://www.nhyoko.med.navy.mil/wellne
98/05-05.htm.
ss/wellness.htm
It also has a compilation of health and
The Wellness Center at the U.S. Naval
medicine-related Internet sites called
Hospital in Yokosuka, Japan offers a
WebMed Links, in which you can find
wide range of information on wellness
research done on various medical fields.
issues including, nutrition, suicide
http://www.cspinet.org./nah/caffeine.htm
prevention, stress management, sexual
This site is called Caffeine: The Inside
health,
and
stress
management.
Scoop. It contains a list of facts and
myths on caffeine, you may find it useful
“We must learn to live together as brothers or perish together as fools.”
--Martin Luther King, Jr.
13
©American Medical Student Association/Foundation, 2001
Notes for Concerned Medical Students
by Patch Adams, M.D., Founder and Director, Gesundheit Institute
heartfelt medical education in exuberant anticipation
Medical education can be a stressful experience. For
of a life in service to humankind. Inherent in helping
some, the academics seem gargantuan, for others the
others is an intoxication of self-satisfaction in a
costs are stifling. But the most disconcerting
garland of intimacy. The keys here are to assert your
feedback is the feedback that is centered on a
own motivation and to respect your wisdom...indeed
depression and anxiety over the kind of climate in
to be bathed in the self-confidence that you can make
which health care is practiced in today’s society. It is
your life a delightful adventure. We offer a few
hard to find joyous service oriented practice in
suggestions here to make your education a highlight
hospitals. So often it appears that economics and
of your life. Please share your feedback and
management come before patient care. Competition
suggestions.
Dialogue with us and your
seems to be more the style than cooperation among
contemporaries in creating a medical celebration.
health professionals. This guide is created for the
medical student who wishes a thrilling, joyous,
Practice being very deep and intimate with each
other. Hold nothing back.
5. Please get involved in the politics of medicine
from the very beginning.
Belong to the American Holistic Medical Association
(AHMA), American Medical Student Association
(AMSA), Office of Student Representatives (OSR) of
the Association of American Medical Colleges, the
American Medical Association (AMA), the
American Academy of Family Physicians (AAFP),
etc. Go to the meetings, especially the big ones, and
talk with everyone. There is gold everywhere. Many
are thinking about the same things you are. Your
fantasy medical practice may sprout in this climate.
6. Yes, fantasize your most outlandish medical
fantasy.
Your degree in medicine is the freedom to choose
exactly how you want to practice. The only limiting
factors will be your fears and your imagination. Band
together and soar.
7. Focus on medicine as service.
Medicine as a business is hurting everyone. The
rewards in medicine are in helping others and in selfdiscovery. Giving is an intoxication, intimacy is a
by-product. Brace yourself for an avalanche of love.
8. This is a whopper. Have outside interests!
You are not a doctor. You are a person who has
studied medicine. You are all of your other interests
just as well. Nurture all of your loves. Experiment
with ways of integrating your interests with your
medicine. Weave these interests into the relationships
you have with your patients. Be open to learning
things from them....you will love the bonds that form.
9. Finally, do not sacrifice your family for your
medical career.
What you learn in keeping your family vibrant will
serve you greatly with your patients. Please cherish
your significant others, your lovers, your children,
your parents, and feel the great health their love gives
you. See your friends as part of your family.
1.
Don’t wait until you are on the wards to
practice and develop your interviewing
skills...start now!
Interview everyone with as great a depth as you dare.
Medicine’s fundamental thrill is intimacy. Find that
kind of demeanor in yourself that delights others so
they tell you their tales. Be ecstatic for the gift that
people give you in love, trust and intimacy. Find a
way to let this journey together stimulate you and fill
you with the excitement of a new friend.
2. As you explore the glorious mechanisms of the
body and life, let it electrify you in wonder and
curiosity. Never get complacent over the miracle of
life. Live in awe. Let this be the focus of your
education...NOT your grades, which will tell you
nothing about the kind of doctor you will be. (When
I was in medical school, I told them never to notify
me about my grades unless I failed...which became
very freeing).
2. Do not let the cost of education paralyze you.
It is a privilege that you are so fortunate to be in
school. When you finish you will pay your loans
back as soon as you can. If you choose serviceoriented medicine, its gift is payback enough until
funds come in. Don’t let the debt trap you in a
repugnant practice. Here creativity and exploration
make great playmates. There is no debtor’s prison.
Community support can be key here.
3. Cultivate
intimacy
with
the
health
professionals and professors you respect.
Invite yourself to their homes. Establish a thriving
dialogue. Ask to come into their practice. Reach out
for the same intimacy with aides, orderlies and nurses
as you do with doctors and patients. The word here is
friendliness wherever you go in life; it will make
your day thrilling.
4. Please have support groups.
Support in study. Support in play. Find like minds
and fantasize your medical interests and futures.
14
©American Medical Student Association/Foundation, 2001
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